The perception may be that people with mental illness are to blame for society’s violence, but psychiatrist James Knoll IV, MD says that is not reality. “If you look at all the violence committed in society, and how much is done by the mentally ill, it is a sliver of a fraction.”

Even so, if someone who sees a psychiatrist regularly makes a threat during a session, does the therapist have a duty to alert law enforcement? Not in New York State, Knoll says, adding, “there is a mental hygiene law that gives therapists the authority to warn, which is different than a duty.” In any case, to be taken seriously, threats must be specific, credible and realistic — and lodged against an identifiable third party.

Knoll advises psychiatrists and other therapists to thoroughly document their decision and reasoning if a patient makes a threat. Among the options: warn the police, warn the third party, increase the frequency of outpatient visits or escort the patient to the emergency room for an evaluation and possible hospitalization.

To be committed, patients must be mentally ill and dangerous.

“It has to be mental illness that causes someone to be a danger to themselves or others. That causal link is crucial,” Knoll says. “If they’re just dangerous, or just mentally ill, that’s not enough.”